2017-2018 OSLA MEMBERSHIP REGISTRATION FORM
REGULAR RATES - AFTER APRIL 1, 2017
FOR YOUR CONVENIENCE … REGISTER ONLINE AT WWW.OSLA.ON.CA
CLICK ON “MEMBERSHIP AND BENEFITS,” THEN ON
First Name: _______________________
Initial: _____
The Ontario Association of
Speech-Language Pathologists
and Audiologists
Last Name: ________________________________________
 Audiologist
 Communicative Disorders Assistant
 Speech-Language Pathologist
 Speech-Language Pathologist & Audiologist
Salutation:
Ms.  Mrs.  Miss Mr.  Dr.
My Primary Mailing Address is
 Home
OR
CASLPO #: __________
 Work
Home Address:
Street: ____________________________________________________ Unit/Suite #: _______________
City: _____________________________ Province: ___ Country: __________ Postal Code: _________
Phone: (
) _____ - __________
Extension: _____
Fax:
(
) _____ - __________
Work Address:
Position Title: _________________________________________________________________________
Organization/Clinic Name: _______________________________________________________________
Department or Division: _________________________________________________________________
Street Address: __________________________________________
Unit/Suite #: ___________
City: ___________________________ Province: ___ Country: ____________ Postal Code: ________
Phone: (
) _____ - __________
Extension: _____
Fax:
(
) _____ - __________
Email Address (Primary): __________________________ (Alternate): _________________________________
Online Interest Groups: Membership in OSLA includes FREE membership in Online Interest Groups – Please check below to
be included on the Online Interest Groups that interest you. There is no restriction on the number of Interest Groups a
member can join. You can add or delete participation in an Interest Group at any time.






ABI
Aphasia
Audiology Issues
Autism
Auto Insurance
CDA Issues
 Childhood Apraxia
of Speech
 Dysphagia
 End of Life/
Palliative Care
 Fluency
 Home/Community Care
 Mental/Emotional Health
Issues
 Multi-Cultural/MultiLingual




 Pre-School
YOU ARE THE KEY TO A HEALTHY, VITAL PROFESSION
Private Practice
SLPs in Education
Technology/APPs
Voice
WHERE WOULD WE
BE WITHOUT OUR VOICE?
2017—2018 Membership Categories & Dues - Regular Rates
Membership Year runs from April 1, 2017 to March 31, 2018.
 General Member:
$260.00 + $33.80 HST = $293.80 (or $24.48/month)
General membership is available to Speech-Language Pathologists and Audiologists working full time (over 800 hours) in their
profession or field. General Members enjoy all of the rights and privileges of membership and have the right to vote and hold
office.
 Reduced Hours:
$185.00 + $24.05 HST = $209.05 (or $17.42/month)
Reduced Hours membership is available to Speech-Language Pathologists and Audiologists eligible to be full members who
work less than 800 hours in the membership year. Reduced Hours members enjoy all of the rights and privileges of membership and have the right to vote and hold office.

New Practitioner:
$135.00 + $17.55 HST = $152.55 (or $12.71/month)
New Practitioner membership is available to Speech-Language Pathologists and Audiologists eligible to be full members in
their first year since graduation and who were OSLA student members in the year immediately prior to graduation. New
Practitioner members enjoy all of the rights and privileges of membership and have the right to vote and hold office.
 Retired:
$48.00 + $6.24 HST = $54.24 (or $4.52/month)
Retired membership is available to former Speech-Language Pathologists and Audiologists who are no longer working in direct client care, administration or teaching. Retired members enjoy all of the rights and privileges of membership and have the
right to vote and hold office.
 Communicative Disorders Assistant
$135.00 + $17.55 HST = $152.55 (or $12.71/month)
Associate membership is available to CDAs (Communicative Disorders Assistants) who are under the supervision of an SLP/
Audiologist. Associate members enjoy all of the rights and privileges of membership, except the right to vote and hold office.
 Student:
Free
Due to the generosity of practicing members, students enrolled in a Masters-level or Doctoral-level Speech-Language Pathology or Audiology programs or in college support personnel programs (e.g. Communicative Disorders Assistants) in Ontario are
eligible to be Student members at no cost.
Payment Information
Amount Due : ______________________________
Method of Payment:
□ Cheque (payable to OSLA)
□ VISA
□ MasterCard
□ American Express
Card #:________________________________________________ Expiry date: _______________
Cardholder’s name: __________________________________ Signature: __________________________
□ Monthly Payment?
(By choosing the monthly payment option, your credit card will be debited with the monthly amount, instead of the full amount
listed above. Your credit card will then be charged monthly with the same amount until the end of the membership year. Please
note that a one-time $10.00 administration fee will apply to the monthly payment option. It will be added to your first payment. )
□ Automatic Renewal?
(This will automatically renew your membership at the early bird rate annually in March. You will be notified one month in advance
of renewal).
*OSLA applies a $20 NSF fee on all dishonoured cheques and for dishonoured credit card submissions.
OSLA GST# 108090879.
410 Jarvis St, Toronto ON M4Y 2G6 ● 416-920-3676 ● 1-800-718-6752 (OSLA) ● Fax: 416-920-6214 [email protected] ● www.osla.on.ca